Excretion of platelet activating factor-acetylhydrolase and phospholipase A2 into nasal fluids after allergenic challenge: possible role in the regulation of platelet activating factor release.

Platelet activating factor (PAF), a proinflammatory mediator synthesized through a phospholipase A2 (PLA2)-dependent reaction, is hydrolyzed into its inactive metabolite, lyso-PAF, by a specific acetylhydrolase. Previous studies have shown that allergen challenge of patients with allergic rhinitis leads to an increase of the concentrations of lyso-PAF in nasal lavage fluid (NLF), whereas PAF is detected only marginally. PAF-hydrolyzing enzymes are expected to be released on allergenic challenge, to account for the reduced concentrations of PAF in NLF. Here, we show that allergen challenge of patients with allergic rhinitis induces an increase of acetylhydrolase-like activity in NLF, which peaks within 10 minutes and returns to basal values 1 hour later. Acetylhydrolase hydrolyzed exogenous PAF with a complete loss of its ability to induce platelet aggregation. Allergen challenge also led to a parallel release of a PLA2 in nasal fluids. This enzyme preferentially hydrolyzes negatively charged phospholipids (phosphatidic acid monomethyl ester and phosphatidylgylcerol) versus phosphatidylcholine. More interestingly, the hydrolysis of phosphatidic acid monomethyl ester and phosphatidylglycerol by NLF was completely abolished by the addition of ethylenediaminetetraacetic acid which had no effect on the hydrolysis of PAF, indicating that the PLA2 secreted in nasal fluids is not involved in the degradation of PAF. Finally, our results show that allergen-induced increase in the concentrations of lyso-PAF and prostaglandin D2 occurred with a kinetic similar to that of tosyl-L-arginine-methyl-ester esterase, suggesting that mast cells are implicated in this process. Although no direct relationship was demonstrated between the absence of PAF and the increase of acetylhydrolase levels in NLF, we suggest a potential role for this enzyme in the inactivation of PAF if the latter is released in the nasal lumen.

Eosinophil infiltration: effects of H1 antihistamines.

This article reviews the contribution of cell-mediated inflammatory responses to the immediate immunoglobulin E-dependent allergic reaction. Apparently eosinophils play an important part in the pathogenesis of allergic reactions. Some new H1 antihistamines may also have non-H1-mediated antiinflammatory properties. In two double-blind, placebo-controlled, crossover studies of allergic and normal subjects, we showed that oral cetirizine, at dosages of 10 and 20 mg/day, significantly inhibited wheal-and-erythema reactions induced by grass pollen, 48/80, histamine, platelet-activating factor acether, and N-formyl-methionyl-leucyl-phenylalanine. In the first study, cutaneous eosinophil migration was significantly inhibited by cetirizine at pollen and 48/80 skin test sites (61%, p less than 0.01, and 53%, p less than 0.01, respectively), although no change was observed at histamine skin test sites. Inhibition of neutrophil accumulation was also observed at pollen and 48/80 sites (41%, p less than 0.1, and 31%, p less than 0.1, respectively). Monocyte accumulation was not affected by cetirizine. In the second study, cetirizine suppressed the eosinophil influx induced by pollen, platelet-activating factor, 400 ng, and platelet-activating factor, 40 ng (63%, p less than 0.001; 58.5%, p less than 0.001; and 57.8%, p less than 0.01, respectively). This inhibition was effective 2 hours after challenge and persisted through hours 4, 8, and 24. N-Formyl-methionyl-leucyl-phenylalanine induced a weak eosinophil accumulation that was inhibited by cetirizine.

In vivo effects of cetirizine on cutaneous reactivity and eosinophil migration induced by platelet-activating factor (PAF-acether) in man.

The aim of the study was to determine the effect of cetirizine, a new potent H1 antihistamine, on acute cutaneous inflammatory response and eosinophil accumulation induced in vivo by platelet-activating-factor (PAF-acether) and allergen. In a double-blind, crossover study, seven subjects allergic to grass pollen and three nonallergic control subjects received orally either cetirizine, 20 mg/day, or placebo for 4 days. On day 4, the subjects were skin tested with grass pollen and PAF-acether (400 and 40 ng per site). After the challenge, an evaluation of time-course cutaneous eosinophil infiltrations by a skin window technique was performed. Cetirizine pretreatment reduced skin wheal and erythema elicited by allergen and PAF, 400 and 40 ng, by 74.6% (p less than 0.001), 53.9% (p less than 0.001), and 47% (p less than 0.01), respectively. Skin reactivity induced by PAF-acether was also significantly reduced by cetirizine in nonallergic subjects. Cetirizine reduced at hour 24 eosinophil infiltrations induced by allergen and PAF, 400 and 40 ng, by 63% (p less than 0.001), 58.5% (p less than 0.001), and 57.8% (p less than 0.01), respectively. This inhibitory effect of cetirizine on allergen and PAF-induced eosinophil infiltration was already effective 2 hours after the challenge. PAF induced a nonsignificant eosinophil influx in all nonallergic subjects. In conclusion, cetirizine inhibited both the immediate cutaneous response and the eosinophil influx induced by allergen and by a potent eosinophil chemotactic factor, such as PAF-acether. Therefore, cetirizine, besides its anti-H1 effect, has the potential to modulate the allergic inflammatory response.

Pharmacological modulation by cetirizine and loratadine of antigen and histamine-induced skin weals and flares, and late accumulation of eosinophils.

In a double-blind, randomized, crossover study performed in atopic subjects, the inhibitory effects of single doses of 10 mg cetirizine and 10 mg loratadine on histamine- and grass pollen-induced skin reactions were evaluated 4 h after drug intake. Cetirizine significantly inhibited histamine- and antigen-induced skin reactions, as well as the accumulation of eosinophils measured 24 h after antigen challenge. Loratadine, however, did not significantly inhibit the skin reactions induced by histamine and grass pollen, nor eosinophil accumulation.

Seasonal increase of spontaneous histamine release in washed leucocytes from rhinitis patients sensitive to grass pollen.

The spontaneous histamine release (SHR) in basophils from patients sensitive to grass pollen has been studied before and during the 1987 grass pollen season. Nineteen patients were recruited on seasonal rhinitis symptoms, positivity for cutaneous tests and for serum-specific IgE with grass pollen. At the time of the biological investigations the patients were following a clinical trial of hyposensitization, including placebo, calcium phosphate and aluminium hydroxide-adsorbed grass pollen extract treatments. During the pollen season, grass pollen counts and clinical scores were checked over a 40-day period. Mean SHR was significantly higher during the pollen period than before, for the whole population of 19 patients (10.9% and 4.6%; P less than 0.005) as well as when the high SHR responders were excluded (5.5% and 3.6%; P less than 0.01). No significant correlation existed between SHR and clinical scores or treatments. SHR could be inhibited at 4 degrees C, in absence of CA++ or of oxidative metabolism and thus originated from cells actively secreting histamine.

Inhibitory effect of cetirizine 2HCl on eosinophil migration in vivo.

The effect of a potent antihistamine, cetirizine, was studied on allergic patients and normal subjects by means of an in-vivo 'skin window' technique. All subjects showed significant inhibition of skin-test responses to grass pollen, compound 48/80, histamine and methacholine, after administration of a single dose (10 mg) of cetirizine. Compared to placebo, cetirizine significantly decreased the eosinophils attraction at skin sites challenged with grass pollen and compound 48/80. In allergic patients no change in eosinophil migration pattern was noted with histamine and methacholine skin-tested sites. In normal subjects, compound 48/80 and histamine did not induce eosinophil accumulation and cetirizine did not modify cellular patterns as compared to placebo. These results suggest that cetirizine acts on eosinophil migration by inhibiting the release of mast cell mediators or inhibiting the eosinophilotactic mediators themselves.